Ethyl glucuronide explained

Ethyl glucuronide (EtG) is a metabolite of ethanol which is formed in the body by glucuronidation following exposure to ethanol, usually from drinking alcoholic beverages. It is used as a biomarker to test for ethanol use and to monitor alcohol abstinence in situations where drinking is prohibited, such as by the military, in alcohol treatment programs, in professional monitoring programs (health professionals, attorneys, airline pilots in recovery from addictions), in schools, liver transplant clinics, or in recovering alcoholic patients.^{[1] [2]} In addition to its use to monitor abstinence and detect drinking, EtG also has potential for monitoring the amount of alcohol use over time because it can be detected in hair and nails, though the effectiveness of this has not yet been proven.^{[3] [4]}

A disadvantage of the test is that because EtG can be detected in samples at very low levels, it can also be positive after exposure to alcohol from non-beverage sources, or incidental exposure, which can lead to false positives. The sources of possible exposure in the environment are numerous and include alcohol in mouthwash, foods, over-the-counter medications, and even from inhalation of alcohol from topical use. It is impossible with this biomarker to distinguish small amounts of drinking from extraneous exposure to alcohol. ^[5]

Hair testing controversy

A growing number of articles are documenting the high sensitivity and specificity of hair (or nail) EtG for detection of heavy drinking.^{[6] [7] [8] [9] [10]}

EtG testing in hair specimens was previously attempted by laboratories in the United Kingdom, but has suffered from numerous lawsuits. Due to the concerns of legal risk, few laboratories offer this type of testing anymore, as it has been determined to be unreliable and unsupportable.^[11] The Society of Hair Testing (SOHT) also notes the limitations of EtG, stating that this form of testing can determine "chronic excessive alcohol consumption only. This consensus is not applicable for determination of abstinence from alcohol or moderate consumption of alcohol." SOHT also states, "It is not advisable to use the results of the hair testing for alcohol markers in isolation".^[12]

The U.S. Substance Abuse and Mental Health Services Administration has cautioned that the test is "scientifically unsupportable as the sole basis for legal or disciplinary action" because the highly sensitive tests "are not able to distinguish between alcohol absorbed into the body from exposure to many common commercial and household products containing alcohol and from the actual consumption of alcohol."^[13]

See also

Other experimental serologic tests (biomarkers) for recent alcohol use include 5-hydroxytryptophol, ethyl sulfate, phosphatidyl ethanol, sialic acid level, β-hexosaminidase, mitochondrial AST levels, and alcohol metabolites such as erythrocyte acetaldehyde and acetaldehyde adducts.

Notes and References

1. Lande RG, Marin B . Biomarker characteristics of alcohol use in the U.S. Army . Journal of Addictive Diseases . 28 . 2 . 158–63 . 2009 . 19340678 . 10.1080/10550880902772506 .
2. Concheiro M, Cruz A, Mon M, de Castro A, Quintela O, Lorenzo A, López-Rivadulla M . Ethylglucuronide determination in urine and hair from alcohol withdrawal patients . Journal of Analytical Toxicology . 33 . 3 . 155–61 . April 2009 . 19371464 . 10.1093/jat/33.3.155. free .
3. Wurst FM, Skipper GE, Weinmann W . Ethyl glucuronide--the direct ethanol metabolite on the threshold from science to routine use . Addiction . Suppl 2 . 51–61 . 98 . December 2003 . 14984242 . 10.1046/j.1359-6357.2003.00588.x. free .
4. Palmer RB . A review of the use of ethyl glucuronide as a marker for ethanol consumption in forensic and clinical medicine . Seminars in Diagnostic Pathology . 26 . 1 . 18–27 . February 2009 . 19292025 . 10.1053/j.semdp.2008.12.005.
5. Rosano TG, Lin J . Ethyl glucuronide excretion in humans following oral administration of and dermal exposure to ethanol . Journal of Analytical Toxicology . 32 . 8 . 594–600 . October 2008 . 19007508 . 10.1093/jat/32.8.594. free .
6. Kharbouche H, Faouzi M, Sanchez N, Daeppen JB, Augsburger M, Mangin P, Staub C, Sporkert F . Diagnostic performance of ethyl glucuronide in hair for the investigation of alcohol drinking behavior: a comparison with traditional biomarkers . International Journal of Legal Medicine . 126 . 2 . 243–50 . 2012 . 21910015 . 10.1007/s00414-011-0619-9 .
7. Politi L, Morini L, Leone F, Polettini A . Ethyl glucuronide in hair: Is it a reliable marker of chronic high levels of alcohol consumption? . Addiction . 101 . 10 . 1408–12 . 2006 . 16968341 . 10.1111/j.1360-0443.2006.01537.x .
8. Morini L, Politi L, Polettini A . Ethyl glucuronide in hair. A sensitive and specific marker of chronic heavy drinking . Addiction . 104 . 6 . 915–20 . 2009 . 19392911 . 10.1111/j.1360-0443.2009.02535.x .
9. Boscolo-Berto R, Viel G, Montisci M, Terranova C, Favretto D, Ferrara SD . Ethyl glucuronide concentration in hair for detecting heavy drinking and/or abstinence: a meta-analysis . International Journal of Legal Medicine . 127 . 3 . 611–9 . 2013 . 23250386 . 10.1007/s00414-012-0809-0 .
10. Boscolo-Berto R, Favretto D, Cecchetto G, Vincenti M, Kronstrand R, Ferrara SD, Viel G . Sensitivity and specificity of EtG in hair as a marker of chronic excessive drinking: pooled analysis of raw data and meta-analysis of diagnostic accuracy studies . Therapeutic Drug Monitoring . 36 . 5 . 560–75 . 2014 . 24577122 . 10.1097/FTD.0000000000000063 . 2318/155920 . free .
11. Web site: Testing Testing: Hair Alcohol Test in The Family Courts. The Barrister .
12. Web site: 2014 Consensus for the Use of Alcohol Markers in Hair for Assessment of both Abstinence and Chronic Excessive Alcohol Consumption. Society of Hair Testing.
13. Center for Substance Abuse Treatment. The Role of Biomarkers in the Treatment of Alcohol Use Disorders. Substance Abuse Treatment Advisory . Volume 5, Issue 4, 2006